Healthcare Provider Details

I. General information

NPI: 1851739296
Provider Name (Legal Business Name): LAURIE ANN LIDIE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 12/19/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4971 BONNYVIEW AVE
REDDING CA
96001-4217
US

IV. Provider business mailing address

4971 BONNYVIEW AVE
REDDING CA
96001-4217
US

V. Phone/Fax

Practice location:
  • Phone: 530-604-3637
  • Fax: 866-789-4966
Mailing address:
  • Phone: 530-604-3637
  • Fax: 866-789-4966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCSW89673
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: